NSG 4800
Study online at https://quizlet.com/_9bymtt
1. The nurse is monitoring a B, During the fourth stage of labor, the maternal blood pressure,
client in the immediate post- pulse, and respiration should be checked every 15 minutes dur-
partum period for signs of he- ing the first hour. An increasing pulse is an early sign of exces-
morrhage. Which sign, if not- sive blood loss because the heart pumps faster to compensate
ed, would be an early sign of for reduced blood volume. A slight increase in temperature is
excessive blood loss? normal. The blood pressure decreases as the blood volume
A .temperature of 100.4°F diminishes, but a decreased blood pressure would not be the
(38°C) earliest sign of hemorrhage. The respiratory rate is slightly
B. An increase in the pulse rate increased from normal.
from 88 to 102 beats/minute
C. A blood pressure change
from 130/88 to 124/80 mm
Hg
D. An increase in the res-
piratory rate from 18 to 22
breaths/minute
2. The nurse in the ambula- 3, Cryotherapy involves the local application of liquid nitrogen
tory care unit is providing to the lesion; this causes cell death and tissue destruction.
home care instructions to a Tissue freezing is followed in 1 to 2 days by hemorrhagic blister
client after cryotherapy for formation; therefore, ice is not applied to the site. The appli-
the treatment of malignant cation of a warm, damp washcloth intermittently to the site will
skin lesions. Which statement provide relief of any discomfort. The nurse instructs the client to
would be most appropriate clean the site with the prescribed solution to prevent secondary
for the nurse to include in infection. A topical antibiotic also may be prescribed. Alcohol
the home care instructions for would cause irritation to the skin. There is no reason for the
this client? client to avoid showering or bathing.
"Apply ice to the site to pre-
vent swelling."
"Clean the site with alcohol 3
times daily."
"Apply a warm, damp wash-
, NSG 4800
Study online at https://quizlet.com/_9bymtt
cloth if discomfort occurs."
"Avoid showering or taking
baths until seen by the health
care provider in 1 week."
3. The registered nurse is car- B
ing for the following clients. A client with uncontrolled Diabetes Mellitus would require the
It would be a priority for the greatest number of disciplines (multidisciplinary) to manage
nurse to initiate a multidis- their care i.e. Medicine, Nursing, Social Work, Nutritionist; the
ciplinary conference for the other choices do not require as many providers of care to meet
client who is their needs.
A.12 years old with Autism
who is starting a new school
and recently had a URI (upper
respiratory tract infection)
B.39 years old, has type 2 Di-
abetes Mellitus, is homeless
and had a recent Hemoglobin
A1c of 13%
C.52 years old, with Myas-
thenia Gravis, recently pre-
scribed Mestinon (pyridostig-
mine) and is employed as a
mail carrier
D.79 years old, has bipo-
lar and schizophrenia, lives
alone and reports hearing
non threatening voices.
4. A client is scheduled to begin D. Carbamazepine may be used to treat a seizure disorder. It
therapy with carbamazepine. can cause leukopenia, anemia, thrombocytopenia, and, very
The nurse should assess the rarely, fatal aplastic anemia. To reduce the risk of serious hema-
, NSG 4800
Study online at https://quizlet.com/_9bymtt
results of which test(s) before tological effects, a complete blood cell count should be done
administering the first dose of before treatment and periodically thereafter. This medication
this medication to the client? should be avoided in clients with preexisting hematological
Liver function tests abnormalities. The client also is told to report the occurrence
Renal function tests of fever, sore throat, pallor, weakness, infection, easy bruising,
Pancreatic enzyme studies and petechiae. The results of the remaining tests listed in the
Complete blood cell count options are not associated with the use of this medication.
5. A client is admitted to a hos- C. Emergency management of DKA focuses on correcting fluid
pital with a diagnosis of dia- and electrolyte imbalances and normalizing the serum glucose
betic ketoacidosis (DKA). The level. If the corrections occur too quickly, serious consequences,
initial blood glucose level is including hypoglycemia and cerebral edema, can occur. During
950 mg/dL (54.2 mmol/L). A management of DKA, when the blood glucose level falls to 250
continuous intravenous (IV) to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is
infusion of short-acting in- reduced and a dextrose solution is added to maintain a blood
sulin is initiated, along with glucose level of about 250 mg/dL (14.2 mmol/L), or until the
IV rehydration with normal client recovers from ketosis. Fifty percent dextrose is used to
saline. The serum glucose lev- treat hypoglycemia. NPH insulin is not used to treat DKA. Pheny-
el is now decreased to 240 toin is not a usual treatment measure for DKA.
mg/dL (13.7 mmol/L). The
nurse would next prepare
to administer which medica-
tion?
An ampule of 50% dextrose
NPH insulin subcutaneously
IV fluids containing dextrose
Phenytoin for the prevention
of seizures
6. A client is being discharged 2; all others responses would indicate IICP and needs to go to
from the emergency depart- the ER
ment after an evaluation for
Study online at https://quizlet.com/_9bymtt
1. The nurse is monitoring a B, During the fourth stage of labor, the maternal blood pressure,
client in the immediate post- pulse, and respiration should be checked every 15 minutes dur-
partum period for signs of he- ing the first hour. An increasing pulse is an early sign of exces-
morrhage. Which sign, if not- sive blood loss because the heart pumps faster to compensate
ed, would be an early sign of for reduced blood volume. A slight increase in temperature is
excessive blood loss? normal. The blood pressure decreases as the blood volume
A .temperature of 100.4°F diminishes, but a decreased blood pressure would not be the
(38°C) earliest sign of hemorrhage. The respiratory rate is slightly
B. An increase in the pulse rate increased from normal.
from 88 to 102 beats/minute
C. A blood pressure change
from 130/88 to 124/80 mm
Hg
D. An increase in the res-
piratory rate from 18 to 22
breaths/minute
2. The nurse in the ambula- 3, Cryotherapy involves the local application of liquid nitrogen
tory care unit is providing to the lesion; this causes cell death and tissue destruction.
home care instructions to a Tissue freezing is followed in 1 to 2 days by hemorrhagic blister
client after cryotherapy for formation; therefore, ice is not applied to the site. The appli-
the treatment of malignant cation of a warm, damp washcloth intermittently to the site will
skin lesions. Which statement provide relief of any discomfort. The nurse instructs the client to
would be most appropriate clean the site with the prescribed solution to prevent secondary
for the nurse to include in infection. A topical antibiotic also may be prescribed. Alcohol
the home care instructions for would cause irritation to the skin. There is no reason for the
this client? client to avoid showering or bathing.
"Apply ice to the site to pre-
vent swelling."
"Clean the site with alcohol 3
times daily."
"Apply a warm, damp wash-
, NSG 4800
Study online at https://quizlet.com/_9bymtt
cloth if discomfort occurs."
"Avoid showering or taking
baths until seen by the health
care provider in 1 week."
3. The registered nurse is car- B
ing for the following clients. A client with uncontrolled Diabetes Mellitus would require the
It would be a priority for the greatest number of disciplines (multidisciplinary) to manage
nurse to initiate a multidis- their care i.e. Medicine, Nursing, Social Work, Nutritionist; the
ciplinary conference for the other choices do not require as many providers of care to meet
client who is their needs.
A.12 years old with Autism
who is starting a new school
and recently had a URI (upper
respiratory tract infection)
B.39 years old, has type 2 Di-
abetes Mellitus, is homeless
and had a recent Hemoglobin
A1c of 13%
C.52 years old, with Myas-
thenia Gravis, recently pre-
scribed Mestinon (pyridostig-
mine) and is employed as a
mail carrier
D.79 years old, has bipo-
lar and schizophrenia, lives
alone and reports hearing
non threatening voices.
4. A client is scheduled to begin D. Carbamazepine may be used to treat a seizure disorder. It
therapy with carbamazepine. can cause leukopenia, anemia, thrombocytopenia, and, very
The nurse should assess the rarely, fatal aplastic anemia. To reduce the risk of serious hema-
, NSG 4800
Study online at https://quizlet.com/_9bymtt
results of which test(s) before tological effects, a complete blood cell count should be done
administering the first dose of before treatment and periodically thereafter. This medication
this medication to the client? should be avoided in clients with preexisting hematological
Liver function tests abnormalities. The client also is told to report the occurrence
Renal function tests of fever, sore throat, pallor, weakness, infection, easy bruising,
Pancreatic enzyme studies and petechiae. The results of the remaining tests listed in the
Complete blood cell count options are not associated with the use of this medication.
5. A client is admitted to a hos- C. Emergency management of DKA focuses on correcting fluid
pital with a diagnosis of dia- and electrolyte imbalances and normalizing the serum glucose
betic ketoacidosis (DKA). The level. If the corrections occur too quickly, serious consequences,
initial blood glucose level is including hypoglycemia and cerebral edema, can occur. During
950 mg/dL (54.2 mmol/L). A management of DKA, when the blood glucose level falls to 250
continuous intravenous (IV) to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is
infusion of short-acting in- reduced and a dextrose solution is added to maintain a blood
sulin is initiated, along with glucose level of about 250 mg/dL (14.2 mmol/L), or until the
IV rehydration with normal client recovers from ketosis. Fifty percent dextrose is used to
saline. The serum glucose lev- treat hypoglycemia. NPH insulin is not used to treat DKA. Pheny-
el is now decreased to 240 toin is not a usual treatment measure for DKA.
mg/dL (13.7 mmol/L). The
nurse would next prepare
to administer which medica-
tion?
An ampule of 50% dextrose
NPH insulin subcutaneously
IV fluids containing dextrose
Phenytoin for the prevention
of seizures
6. A client is being discharged 2; all others responses would indicate IICP and needs to go to
from the emergency depart- the ER
ment after an evaluation for
